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Gastroenterology  (Expert Forum)
 | 
Undiagnosed right lower quadrant abdominal pain...
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D. Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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MedHelp Member's Question

Undiagnosed right lower quadrant abdominal pain...

by chriscan, Feb 02, 2006 12:00AM
Hi

I am a healthy (except for pain) 30 year old female who has been suffering from intermittent, chronic right lower quadrant abdominal pain for the last 15 months.   I've seen an internalist, ob-gyn, gastroenteroligist, and urologist.  These are the tests I have had:

1) several ct scans, two with a barium enema and one with contrast

2) cystoscopy (they thought I had a kidney stone stuck in my ureter)

3)Upper GI

4)colonoscopy

5) laparoscopic surgery by my ob-gyn (found peritoneal fluid around uterus, no signs of endometriosis)

6) ultrasound (found normal ovarian cysts and one 2 mm kidney stone in right kidney)

6) many blood tests, to the extent I'm not quite sure

Everything has come back negative.



My symptoms are very irregular...sometimes I think they are cyclical with my menstrual cycle and when I ovulate, sometimes it's after eating.  If I put my hand on my abdomen while I'm in pain, I feel a lot of intestinal movement.  I have a lot of lower back pain.  I also have pain in my buttocks that goes through my leg, and also below my right shoulder blade.  Bowel movements hurt and even sometimes when I urinate.  Sometimes I feel as if my uterus is prolapsing because I feel pressure.



My gallbladder looked normal in the laparsopic surgery...could my doctors be missing something?  What about my pancreas?  I assume all of those things would have been checked.  The only time I am not in pain, is at night when I'm asleep and a couple hours in the morning.  And it hurts more when I sit for a long time or if I don't exercise.  I'm on progesterone, just "in case" it's gynecologically related.  The pill seemed to be working for a few months, but now I'm back to everyday pain.  Is it possible to have missed endometriosis upon laprasopic surgery?  And, is there any other (non-invasive) diagnostic road I should take?  Neurologist?  Psychiatrist?  MRI?



I should also mentioned that I suffer from anxiety that I have been medicated for in the past, but not at the moment.  Is this all in "my head"?  I'm not a hypochondriac, because I've accepted the results (for the most part)...but I'm still in pain and I don't know what to do...it's affecting the quality of my life with my husband and 2 children...and I do still sometimes worry that something was missed...



Thank you for your help...
Doctor's Answer

by Kevin Pho, MD, Feb 03, 2006 12:00AM
You have been throught a comprehensive evaluation.  If there was a major abdominal disease present, it would have shown up in some for on the tests that you have had.  



The pancreas typically presents with left upper quadrant pain.  



You can consider more specialized testing at this time.  The right lower quadrant is in the area of the terminal small bowel - and sometimes can be difficult to image, despite the upper GI series or colonoscopy.  



You can consider a small bowel series, as well as capsule endoscopy, to further evaluate the small bowel for an inflammation or possible Crohn's disease.



If the testing remains negative, you can consider irritable bowel syndrome.  Treatment can be considered with anti-spasmodic agents.  If there is constipation present, Zelnorm can be tried.



This option can be discussed with your personal physician.



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Kevin, M.D.

kevinmd_b
Member Comments (9)

by NickyIsHere123, Feb 03, 2006 12:00AM
To: OP
Hi, you sound a lot like myself. I actually had what is called a HIDE scan test done to measure the gallbladder's function. Usually they give a percentage back on the results. Anything below 35% is considered "abnormal", but this whole idea of gallbladder malfunction is not fully understood. They do not know for sure what causes it. I WISH THEY WOULD!!! Perhaps so many gallbladders be not needlessly removed. At any rate, I would try having this done. Another route would be nerve damage or neuropathy of some kind. How you got it, it could be from a prior surgery or could be from infection maybe. You did mention the fluid build up. I am wondering if that is not the cause of pain. In any regard, you have to make a choice to help your body heal , and I would suggest starting with your diet. You body can heal itself, it has to have certain properties though. You may want to consider researching juicing and the power in food. I did this, and have turned my condition around. I have also read where several medical doctors have witnessed the same thing ( i.e. Dr. SAndra Cabot). Finally, think very carefully about having more CT scans performed. This test sends the same amount of radition into your body that was found in dome survivors of the Hiroshima bombings. They do not tell you this when you have the test, but they are not sure what the aftermath of the test will bring (i.e. tumors) Just THINK...some of these doctors send patients to more that one CT scan a year, and I believe this is wrong. You need to take a look at both sides of the coin at all times.



Good Luck and hope this helps!

by NickyIsHere123, Feb 03, 2006 12:00AM
To: op
Think the days of mad scientists are gone?



Just take note of a paper written on CT scans:



http://www.mindfully.org/Nucs/2004/Full-Body-CT-Scans31aug04.htm













by chriscan, Feb 03, 2006 12:00AM
Thank you for your comments, I appreciate the quick response.  I see my ob-gyn today, and will bring up the idea of these further tests.  And, I quite agree, no more cat scans for me...I have had enough radiation this last year to last 2 lifetimes...but it's always a doctors first diagnostic test to use...

by dcdre14, Feb 03, 2006 12:00AM
Hi,



Have you had your appendix evaluated... or maybe already removed?



I suffered from vague lower right quadrant pain on and off for two years... I visited my regular doctor about it many times.. Sometimes it would get so bad I'd go to the ER, where they'd perform the requisite series of tests (blood work, physical exam, the occasional CT scan) before telling me I had any number of minor ailments (gastritis, colitis, IBS, IBD, constipation, anxiety issues, an ulcer... even a pulled abdominal muscle)!!!



During one particularly acute episode, I went to a more reputable ER, where they suspected I had "chronic appendicitis" - a rare condition in which the appendix flares up mildly every once in a while (as opposed to what it normally does when it's inflamed - ruptures!!!).



They took my appendix out two days later, and I have been pain-free since...



I guess some doctors debate whether chronic